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			<title><!--%nom_fonction%--></title>
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		<div id="sf_menu1">
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        			<!--%loop:messages%-->
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        			<!--%endLoop:messages%-->
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			<!-- /*******************************/ -->
		<div class="corps1">
			
			<form action="<!--%edit_action%-->" method="post" name="form1" id="form1">
					<div class="imgleft"></div>
					<div class="imgmiddle">
						<div class="btn"><span class="btnleft"></span><span class="btnmiddle"><h5><!--%nom_fonction%--></h5></span><span class="btnright"></span></div>
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						<div class="us1">
							<table>
								<!--%loop:champ_input%-->
								
								<!--%if:isset($['label_input'])%-->
								<tr>
									<td><!--%label_input%--></td>
								    <td><input type="text" name="<!--%input_name%-->" maxlength="<!--%maxlength%-->" class="<!--%class%-->" value="<!--%input_value%-->" size="40" /></td>
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								<!--%endIf%-->
								
								<!--%if:isset($['label_select_1'])%-->
								<tr>
								  	<td><!--%label_select_1%--></td>
								  	<td>
								  		<select name="<!--%select_name_1%-->">
								  		<!--%loop:options_1%-->
								  			<option value="<!--%option_value_1%-->" <!--%if:isset($['selected_1'])%-->selected="selected"<!--%endIf%-->><!--%option_name_1%--></option>
								  		<!--%endLoop:options_1%-->
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								<tr>
								  	<td><!--%label_select_2%--></td>
								  	<td>
								  		<select name="<!--%select_name_2%-->" >
								  		<!--%loop:options_2%-->
								  			<option value="<!--%option_value_2%-->" <!--%if:isset($['selected_2'])%-->selected="selected"<!--%endIf%-->><!--%option_name_2%--></option>
								  		<!--%endLoop:options_2%-->
								  		
									  	</select>
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								<!--%endIf%-->
								
								<!--%endLoop:champ_input%-->
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						<input  type="submit" name="Modifier" value="Modifier" class="resizeall btmiddle" <!--%if:isset($['disabled'])%--> disabled="disabled" <!--%endIf%-->/>
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		  			<input type="hidden" name="<!--%hidden_id_name%-->" value="<!--%hidden_id_value%-->" />
		  			<input type="hidden" name="MM_update" value="form1" />
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